Region 15 Regional Healthcare Partnership 6 th Public Meeting

1. Region 15Regional Healthcare Partnership6th Public Meeting Wednesday, September 26, 2012 University Medical Center of El Paso Anchor Hospital

2. Confirmation of Participants • Role Call

3. UMC Projects • Refer to RHP Website • DSRIP Projects • Parallel Universe Projects • Questions • Next Steps

4. HHSC Webinar UpdatesRHP Planning Protocol Webinar 9/25/12 • Project options • Continuous Quality Improvement • QI Milestones are included with each project that requires QI under Process Milestones. For example, for Project 1.3 Implement a Chronic Disease Management Registry you can find these process milestones on pg 35 starting with P-12 – P-14 • Category 3 – 13 Outcome Domains (OD) • 1 stand alone measure • 1 stand alone measure and 1 non-stand alone measure • 3 non-stand alone measures • Or create a measure that meets the definition of ‘outcomes measure’ • Or To Be Determined TBD • We will report on Category 3 Measures on an annual basis • Category 4 – 5 Required Reporting Measures • One was just added as optional – Adult or Child Core Measures for CHIP/Medicaid Population • Non-Hospital Performing Providers – No Category 4 Reporting Requirements

5. HHSC Webinar Updates RHP Plan Template Webinar 9/26/12

6. Final DSRIP MenuCategory I Project Areas • Expand Primary Care Capacity • Increase Training of Primary Care Workforce • Implement a Chronic Disease Management Registry • Enhance Interpretation Services and Culturally Competent Care • Collect Valid and Reliable Race, Ethnicity and Language (REAL) Data to Reduce Disparities • Expand Access to Urgent Care and Enhance Urgent Medical Advice • Introduce, Expand, or Enhance Telemedicine / Telehealth • Increase, Expand, and Enhance Dental Services

7. Final DSRIP MenuCategory I Project Areas (cont.) • Expand Specialty Care Capacity • Enhance Performance Improvement and Reporting Capacity • Implement technology-assisted services (telehealth, telemonitoring, telementoring, or telemedicine) to support, coordinate, or deliver behavioral health services • Enhance service availability (i.e., hours, locations, transportation, mobile clinics) to appropriate levels of behavioral health care • Development of behavioral health crisis stabilization services as alternatives to hospitalization. • Develop Workforce enhancement initiatives to support access to behavioral health providers in underserved markets and areas (e.g., psychiatrists, psychologists, LMSWs, LPCs and LMFTs)

8. Final DSRIP MenuCategory II Project Areas • Enhance / Expand Medical Homes • Expand Chronic Care Management Models • Redesign Primary Care • Redesign to Improve Patient Experience • Redesign for Cost Containment • Implement Evidence-based Health Promotion Programs • Implement Evidence-based Disease Prevention Programs • Apply Process Improvement Methodology to Improve Quality / Efficiency • Establish / Expand a Patient Care Navigation Program • Use of Palliative Care Programs • Conduct Medication Management

9. Final DSRIP MenuCategory II Project Areas (cont.) • Implement / Expand Care Transitions Programs • Provide an intervention for a targeted behavioral health population to prevent unnecessary use of services in a specified setting (i.e., the criminal justice system, ER, urgent care etc.) • Implement person-centered wellness self-management strategies and self directed financing models that empower consumers to take charge of their own health care • Integrate Primary and Behavioral Health Care Services • Provide virtual psychiatric and clinical guidance to all participating primary care providers delivering services to behavioral patients regionally • Establish improvements in care transition from the inpatient setting for individuals with mental health and / or substance abuse disorders • Recruit, train and support consumers of mental health services to provide peer support services • Develop Care Management Function that integrates primary and behavioral health needs of individuals

10. Sample Project Milestones and Metrics • Choose Category 1 or 2 • Choose Project within that Category • Choose Project Option • Include all elements from RHP Plan DSRIP Narrative Section (pg 7-15)

11. Category 1 and 2 Process Milestones • Choose minimum of One Process Milestone for the first two years (you can choose more) P-1, etc. • You must choose the metric associated with the chosen process milestone to assess or implement within the first two years. P-1.1, etc. • You can also keep process milestones through the 4 years if you want (not sure if that’s beneficial)

12. Category 1 and 2 Improvement Milestones • Choose minimum of One Improvement Milestone for the last two years (you can choose more) I-1, etc. • You must choose the metric associated with the chosen improvement milestone to assess or improve upon in the last two years. I-1.1, etc. • You can choose the same measure and metric to improve more upon in the last year.

13. Category 3 Process Measures to fit with Category 1 and 2 Projects • In years DY 2 and DY3, we must choose a Category 3 Process Milestone for each project and provide a narrative of goals and rationale: • Category 3 Process Milestones: • P-1 Project Planning – engage stakeholders, identify current capacity and needed resources, determine timelines and document implementation plans • P-2 Establish Baseline Rates • P-3 Develop and Test Data Systems • P-4 Conduct PDSA Cycles to Improve Data Collection and Intervention Activities • P-5 Disseminate Findings, including Lessons Learned and Best Practices, to Stakeholders • P-7 Other activities not described above • These Milestones may be redundant / complimentary to Category 1 and 2 Milestones

14. Category 3 Improvement Measures or Outcomes Domains to fit with Category 1 and 2 Projects • Outcome Improvement Targets • DY4 and DY5 Outcomes/Improvement Targets: • OD-1 Primary Care and Chronic Disease Management • OD-2 Potentially Preventable Admissions • OD-3 Potentially Preventable Readmissions (30 Day Readmission Rates) • OD-4 Potentially Preventable Complications and Health Care Acquired Conditions • OD-5 Cost of Care • OD-6 Patient Satisfaction • OD-7 Oral Health • OD-8 Perinatal Care • OD-9 Right Care in Right Setting and Patient Centeredness • OD-10 Functional Status • OD-11 Health Disparities • OD-12 Primary Care and Primary Prevention • OD-13 Palliative Care • Can also Propose Outcomes not included in the list, i.e. outcomes that fit the ‘outcomes definition’ • Improvement Targets can also start in earlier years

15. Category 4 Reporting Measures • Hospital Performing Providers Only • Pay for Reporting • 5 Required Domains: • RD-1 Potentially Preventable Admissions (PPA) • RD-2 30 Day Readmissions • RD-3 Potentially Preventable Complications (PPC) • RD-4 Patient Centered Healthcare • RD-5 Emergency Department • 1 Optional Domain • Initial Core Set of Health Care Quality Measures for Children (CHIP) or Adults (Medicaid) eligible

16. Performing Provider Workbooks • Walk-through • Questions

17. UC ToolDue 10/26/12 to HHSC • Walk-through • Questions

18. Medicaid Waiver Timelines • As of 9/24/12, HHSC has formal approval from CMS for: • PFM Protocol • RHP Planning Protocol • RHP Plan Template • As of 9/25/12, the final UC Tool was released for Provider Input • Due to HHSC 10/26/12 • Two weeks after approval – IGT Entities and Private Hospitals submit their final Chapter of Projects to Anchor – Due to Anchor 10/12/12 • October 31, 2012 – Submit RHP to HHSC (4 year plans) • December 15, 2012 - CMS completes review • RHPs returned for revisions during the 30 day period • January 15, 2013 - Revised RHP Plans to CMS • February 1, 2013 - CMS Final Decision

19. Roundtable

20. Contact Information • Waiver Website & Email Address: • http://www.hhsc.state.tx.us/1115-waiver.shtml • TXHealthcareTransformation@hhsc.state.tx.us • UMC Website: • http://www.umcelpaso.org • Region 15 - RHP • Paso del Norte Blue Ribbon Committee Needs Assessment: • http://www.elpasotexas.gov/health/_documents/BRCGapBook.pdf